Clinical characteristics in Japanese children with nonobese type 2 diabetes

Abstract

It is well known that the incidence of youth-onset type 2 diabetes is increasing worldwide. On the other hand, most studies have shown that the majority of youth-onset type 2 diabetes occurs in obese individuals, generally with a body mass index (BMI) greater than the 90th or 95th centile for sex- and age-matched children and adolescents. However, we identified some Japanese children with nonobese type 2 diabetes and BMI less than 90th centile by a urine glucose screening program at schools in the Tokyo Metropolitan Area. According to the results obtained from the screening, clinical characteristics of patients with nonobese type 2 diabetes seemed to be different from those in obese type 2 diabetes. Nonobese patients tended to show lower insulin secretion abilities and milder, but evident, insulin resistance from the time of diagnosis. Female, low birth weight (small for gestational age), and genetic background, not related to β-cell-associated autoimmunity, may play a role in development of nonobese type 2 diabetes. In addition, nonobese patients tend to progress earlier to pharmacological treatment including oral hypoglycemic drugs and insulin. Further studies are needed to confirm to these findings and clarify the pathophysiology of children with nonobese type 2 diabetes.

Glucose metabolism disorders in children with refractory nephrotic syndrome

“…It has been reported that the 14 association of obesity with glucose metabolism disorders is not as strong in children and adolescents as it Caucasian children and approximately 10%-15% of Japanese children with type2 diabetes exhibit normal weight with mild insulin resistance and substantial insulin secretion failure. [29,30] It is popularly thought that basic genetic defect of the β cell is required for the development of type 2 diabetes, and insulin resistance is merely an acquired stimulus. [31] In the face of severe peripheral insulin resistance, patients who cannot maintain adequate β-cell secretion, probably because of genetically determined factors, easily develop glucose metabolism disorders.…”

Visceral Fat Area Measured by Abdominal Bioelectrical Impedance Analysis in School-Aged Japanese Children

“…In adults, it was reported that men have a higher tendency to accumulate VFA compared to pre-menopausal women [ 33 ]. In addition, it was reported that the Asian population is more susceptible to metabolic derangement induced by mild obesity than the Caucasian population [ 34 ]. There are few reports about the difference in VFA in children.…”

<p>The Characteristics Of Abdominal Fat Distribution In Japanese Adolescents With Type 2 Diabetes Mellitus</p>

“…On the other hand, the SFA in the former was lower than that in the latter. Some non-obese Japanese children with type 2 diabetes mellitus have a large amount of visceral fat, even though their body weights and SFAs appear normal for their age and sex, while their V/S ratios are high 3…”

“…Abdominal obesity is highly associated with metabolic risk factors, even in childhood 1. Furthermore, the incidence rate of youth-onset type 2 diabetes mellitus is increasing worldwide,2,3 and the Asian population is reportedly more susceptible to metabolic derangement induced by mild obesity than is the Caucasian population 3. Even though the average body mass index (BMI) of Asians is lower than that of Caucasians, the prevalence of type 2 diabetes mellitus is higher in Asians, possibly owing to the greater accumulation of visceral adiposity other than subcutaneous fat 4.…”